Breathing difficulties due to pressure on the lungs and heart from a compressed rib cage

Rarely, cor pulmonale—right-sided heart failure caused by high blood pressure in the arteries of the lungs

Diagnosis

You will be asked about your child's symptoms and medical history. A physical exam will be done. Scoliosis can be diagnosed on examination of the back and spine. The exam may include:

Assessing posture and spinal curvature in the upright position

Adam's forward bend test to:

Look at spinal curvature

Detect imbalances in the rib cage

Look for other abnormalities along the back

Pattern of movement while walking

Checking the skin to look for abnormal lesions

Scoliometer—a measurement device used to assess the curvature and rotation of the spine

X-rays are usually done to:

Check the severity of scoliosis by measuring the Cobb angle

Detect vertebral or structural abnormalities

Assess level and pace of bone development.

Your child's doctor may recommend other tests to see if the scoliosis is caused by an underlying health condition.

Treatment

Functional scoliosis is reversible with treatment of the underlying condition.

Children with structural types of scoliosis will be referred to a spinal specialist if treatment is needed.

Scoliosis treatment depends on many factors. These include:

Severity of the curve

Child's age

Child's stage of growth

If back pain is involved, or other if your child has other symptoms

In general, children with a mild curve are treated with observation. This means your child will have regular follow-up exams and sometimes x-rays to see if the curve worsens. Frequency of follow-up appointments depends on age, stage of growth, and the severity of the curve. Physical therapy may be helpful to manage pain and optimize your child’s function.

Other treatment methods include:

Bracing or Casting

The goal of bracing or casting is to prevent curves from getting worse. The doctor may recommend that your child wear a
back
brace or a cast if they are still growing and the curve is more than 20-25 degrees, but less than 40 degrees or has progressed more than 10 degrees. Once growing stops, the need for more treatment will depend on the size of the curve and how it affects your child's appearance and function. Physiotherapy scoliosis specific exercises may also be advised.

Bracing may not be helpful in girls who have had their period for more than a year, in children who have attained full growth, or are within one year of full pelvic bone growth. It may not be helpful in infants as well.

Bracing will feel uncomfortable at first. Children will need lots of support to wear the brace as prescribed, as well as encouragement to foster a positive body image.

Surgery

In severe cases where the curvature is greater than 40-45 degrees, your child's doctor may recommend surgery to lessen the curve or stop it from worsening if they are still growing. If they are done or almost done growing, it may be recommended for a curve greater than 50 degrees.

Surgery in teenagers typically involves fusing the vertebrae of the spine together or the use of internal rods to decrease the curvature. Surgery in younger children usually does not involve fusion and may rods that can be lengthened as your child grows. Hospitalization can last 5-7 days. Recovery can take several months. Surgical techniques using stapling methods or implants, as well as other surgical techniques, are also available, but some are still experimental.

Prevention

There are no current guidelines for preventing scoliosis because the cause is usually unknown.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Idiopathic scoliosis in children and adolescents. American Academy of Orthopedic Surgeons Ortho Info website. Available at:
http://orthoinfo.aaos.org/topic.cfm?topic=A00353. Updated March 2015. Accessed May 16, 2017.

Questions and answers about scoliosis in children and adolescents. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at:
http://www.niams.nih.gov/Health%5FInfo/Scoliosis/default.asp. Updated December 2015. Accessed May 16, 2017.

What is scoliosis? Fast Facts: An Easy-to-Read Series of Publications for the Public. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at:
http://www.niams.nih.gov/Health%5FInfo/Scoliosis/scoliosis%5Fff.asp. Updated November 2014. Accessed May 16, 2017.